Which type of mammograms are classified as covered diagnostic tests based on specific criteria?

Diagnostic mammograms are classified as covered diagnostic tests because they are performed to evaluate a specific breast problem or abnormality that has been detected through screening or physical examination. Unlike screening mammograms, which are conducted on asymptomatic patients to catch potential issues early, diagnostic mammograms are tailored to patients who are already experiencing symptoms, such as lumps, pain, or unusual changes in the breast tissue.

These tests often include additional imaging techniques and may involve more detailed views or additional diagnostic tools to arrive at a conclusive assessment of the findings. Because they provide crucial information for diagnosis and treatment, they meet the criteria for medical necessity, making them eligible for coverage by health insurance plans.

In contrast, screening mammograms, while important for preventive healthcare, are generally considered separate from diagnostic testing since they do not target known issues. Therapeutic mammograms are not recognized as a standard classification in the context of diagnostic imaging related to breast health, and while 3D mammograms are an advanced form of imaging, they can be used in both screening and diagnostic contexts but do not inherently classify as a covered diagnostic test on their own without the context of an abnormal finding.